Field of Work: Increase access to substance abuse treatment by improving the quality and efficiency of the delivery system.
Problem Synopsis: Patients requesting substance abuse treatment encountered barriers such as difficult admission procedures, poorly designed telephone systems and an un-engaging reception staff. Instead of an appointment, they often received a request to "call back later." In 2003, Acadia Hospital of Bangor, Maine received an average of 320 calls each week from people seeking treatment. In addition, many of the 1,000 people who called each week asking for mental health services also suffered from substance abuse disorders.
Synopsis of the Work: From September 2003 to June 2006, Acadia participated in the Robert Wood Johnson Foundation (RWJF) Paths to Recovery national program. Participating agencies used process improvement strategies originally developed by private industry to improve business operations.
Acadia's Paths to Recovery team began by redesigning the admissions process to accommodate an unlimited number of new admissions each day. The first step was to stop giving appointments altogether.
Key Results: The immediate result of eliminating appointments was that average time from first call to first contact fell from 4.1 days to 1.3 days. The percentage of clients who were screened and then went on to seek treatment rose from 25 percent to 65 percent.
Providing service on demand brought a different type of client to Acadia. The "new" clients were typically younger, addicted to opiates rather than alcohol or marijuana and relatively new to treatment. These clients forced Acadia staff to rethink the agency's clinical program.
Acadia's change team moved on to its next goal: reducing wait times in the methadone program. By redesigning the intake process to allow laboratory work, physician visits, nursing assessments and clinician interviews all to occur in the same morning, staff:
- Reduced the average time from initial assessment to first day of medication from 3.25 days to less than one-half day
- Increased the number of patients receiving medication on the day of admission ("same day dosing") from 19 percent to 62 percent
- Cut the number of patients waiting two or more days for the first dose of medication from 65 percent to 2 percent
In a report to RWJF, Acadia noted that its experiences had affected state policies as well.